Proctosigmoiditis: Causes, Symptoms, Treatment, Complications

Reviewed By: Pramod Kerkar, MD, FFARCSI

What is Proctosigmoiditis?

Proctosigmoiditis is a variant of ulcerative colitis which basically affects the sigmoid colon. The sigmoid colon joins the large intestine to the rectum from where waste products after digestion are passed in the form of stools. Proctosigmoiditis is also known by the name of ulcerative proctitis. This condition does not involve majority of the colon, but still is significant enough to cause a variety of symptoms.

About half of the population diagnosed with ulcerative colitis tends to have Proctosigmoiditis. Diarrhea, abdominal pain, unintentional weight loss, and fever are some of the characteristic features of Proctosigmoiditis. There are various medications available for treatment of Proctosigmoiditis including steroids. Surgery may be required to remove the diseased portion of the colon in severe cases of Proctosigmoiditis.

What Causes Proctosigmoiditis?

Chronic inflammation of the colon is the root cause for the development of a condition like Proctosigmoiditis. This is quite similar to many variants of ulcerative colitis. The cause for this inflammation is believed to be as a result of immune system response, the reason for which is not exactly known and research is still ongoing in that regard.

The risk of developing Proctosigmoiditis differs from person to person. Some of the risk factors that may result in the development of Proctosigmoiditis are:

Family history of ulcerative colitis

History of being infected with Salmonella or Campylobacter

Living at hill stations

Although these factors may increase the risk of an individual getting Proctosigmoiditis, but it does not mean that the individual will definitely have this at some point.

What Are The Symptoms of Proctosigmoiditis?

The primary presenting feature of Proctosigmoiditis is diarrhea. The frequency of stools may in some cases increase up to five times a day. In some cases, blood may also be seen in stools as a result of the inflammation of the colon causing Proctosigmoiditis.

Irritation of the rectum due to continuous passing of stools may cause an individual to feel the need to have a bowel movement almost on a constant basis, although when attempting to pass bowel the amount of stool passed may be extremely little.

Some of the other symptoms of Proctosigmoiditis are:

Pain in the abdomen

Rectal pain

Fever

Unintentional weight loss

Constipation

Rectal bleeding

Persistent rectal bleeding or spots of blood in the stool require emergent evaluation to rule out any other potentially serious condition causing these symptoms.

How is Proctosigmoiditis Diagnosed?

Colonoscopy is the best way to identify and diagnose Proctosigmoiditis. During a colonoscopy an endoscope is inserted through the rectum and with the camera that is present in the endoscope, the colon and the rectum is visualized and observed for any inflammation. The presence of inflammation in the sigmoid colon will confirm the diagnosis of Proctosigmoiditis.

How is Proctosigmoiditis Treated?

Majority of the cases of Proctosigmoiditis is treated with medications, as large part of the colon is not involved in this medical condition. ASA is the frontline treatment for Proctosigmoiditis. The medication of choice for treatment of Proctosigmoiditis is termed as mesalamine, which is an antiinflammatory medicine. It is available in the form of pills that can be taken orally and also in the form of enemas. If an individual is not able to tolerate enemas, then the patient can take the oral form of this medication.

If mesalamine is ineffective then steroids may be used to calm down the inflammation causing Proctosigmoiditis. Remicade is yet another drug that tends to slow down the immune response and hence calm down the inflammation causing Proctosigmoiditis.

In severe cases of Proctosigmoiditis, surgery is the route taken by the physicians to remove the diseased part of the colon in its entirety and thus, treating Proctosigmoiditis.

What Are The Complications of Proctosigmoiditis?

Cancer is the most serious complication of Proctosigmoiditis. Individuals with Proctosigmoiditis are at risk for developing cancer of the bowels if they have been dealing with this condition for quite a number of years.

Toxic Megacolon: This is yet another complication seen in individuals with Proctosigmoiditis. In this condition, the colon dilates as a result of severe inflammation.

Anemia: This can result due to the blood loss as a result of inflamed intestines and is a common complication of Proctosigmoiditis.